A Guide to Billing for Care Management Services

Chronic Care Management (CCM)

CCM codes (99490, 99491, etc.) reimburse for the non-face-to-face time spent managing patients with two or more chronic conditions. This includes care planning, medication reconciliation, and coordinating with other providers. The key to successful CCM billing is meticulous time tracking by clinical staff and obtaining written patient consent before initiating the service. These are monthly codes, so you can bill them for each month you meet the time and documentation requirements.

Transitional Care Management (TCM)

TCM services (CPT codes 99495 and 99496) are for managing a patient's transition from an inpatient setting (like a hospital or skilled nursing facility) back to their home. Billing for TCM has strict requirements: you must make contact with the patient within two business days of discharge and have a face-to-face visit within 7 or 14 days, depending on the complexity. The codes offer high reimbursement rates, but you must adhere to the timeline perfectly.

Don't Miss the Window: Failure to meet the 2-day contact or 7/14-day visit window will make the entire service non-billable. Having a solid workflow to track hospital discharges is essential.

Key Strategies

Care Management Checklist

✓ Obtain written patient consent before billing for CCM.
✓ Use a reliable system to track all time spent on CCM activities.
✓ For TCM, contact patients within 2 business days of discharge.
✓ Schedule the face-to-face TCM visit within the required 7 or 14-day window.

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CCM and TCM are highly valuable but often underutilized. We help internal medicine practices implement the workflows needed to capture this revenue and get paid for the crucial work of care coordination.

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A Guide to Billing for Care Management Services

A Guide to Billing for Care Management Services

A guide for internal medicine on billing for Chronic Care Management (CCM) and Transitional Care Management (TCM) to get paid for vital care coordination work.

A guide for internal medicine on billing for Chronic Care Management (CCM) and Transitional Care Management (TCM) to get paid for vital care coordination work.

Preston M Voutsi

Article Published

Chronic Care Management (CCM)

Transitional Care Management (TCM)

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